Monday, February 27, 2017

Clinic Owner Sentenced In Manhattan Federal Court To Five Years In Prison In $70 Million Scheme To Defraud Medicare And Medicaid

Fraud Ring, with Three Clinics in Brooklyn and Queens, Paid Kickbacks to Individuals to Undergo Medically Unnecessary Tests

Preet Bharara, the United States Attorney for the Southern District of New York, announced that VICTOR LIPKIN, a former owner of a health care clinic in Brooklyn, New York, was sentenced to five years in prison for his role in a massive health care fraud scheme through which three medical clinics in Brooklyn and Queens submitted over $70 million in fraudulent claims to Medicaid and Medicare. On August 3, 2016, LIPKIN pled guilty to conspiracy to commit wire fraud, mail fraud, and health care fraud. LIPKIN was sentenced last Friday, February 24, in Manhattan federal court by the Honorable Ronnie Abrams.

Manhattan U.S. Attorney Preet Bharara said: “Victor Lipkin spearheaded a scheme that involved recruiting disadvantaged and homeless people to undergo expensive and unnecessary medical tests. Lipkin and his co-defendants submitted over $70 million in bogus claims to Medicare and Medicaid, burdening those programs while enriching themselves.”

According to the Superseding Indictment to which LIPKIN pled guilty, and other publicly filed information in this case:

The Heath Care Fraud Scheme

From 2005 to November 2014, LIPKIN, Vadim Zubkov, Eduard Zavalunov, Nikoloz Chochiev, Anatoliy Fatkhov, Mariana Swaffar, Jacqueline Pinez, Jonathan Oliver, Jason Brissett, Gilbert Trotman, and Giorgi Buleishvili engaged in a scheme to operate three medical clinics in Brooklyn and Queens, through which they recruited financially disadvantaged and homeless people insured by Medicare and/or Medicaid (the “Phony Patients”) to undergo unnecessary medical tests, typically performed by unlicensed personnel, at the clinics in exchange for cash, and then billed the insurers for administering those unnecessary tests. Beginning in or about 2005, LIPKIN and Zubkov recruited and paid a particular licensed physician (the “Doctor”) to act as the nominal owner and/or physician under whose name three purported medical clinics would bill Medicare, Medicaid, and private insurance providers (the “Insurance Providers”) for unnecessary services and tests – including sleep tests and stress tests – performed at the clinics. The clinics were located on Avenue V in Brooklyn, New York – the clinic owned and operated by LIPKIN – and on Hillside Avenue and Elmhurst Avenue, respectively, in Queens, New York. LIPKIN and Zubkov were, in fact, the beneficial owners of the clinics, but they concealed their ownership through the Doctor’s nominal affiliation with the clinics, and by laundering the proceeds of the clinics’ operation through shell companies that they owned and controlled. LIPKIN, Zubkov, Zavalunov, and Buleishvili operated and controlled the clinics, and ran the clinics’ day-to-day operations, despite the fact that they were not licensed physicians, as required by New York law.

At the direction of LIPKIN, Zubkov, Zavalunov, and Buleishvili, other members of the scheme, including Oliver, Brissett, and Trotman (the “Runners”), as well as Chochiev, recruited financially disadvantaged individuals with Medicaid and/or Medicare insurance to act as Phony Patients and undergo unnecessary medical tests at the clinics in exchange for cash payments. The Runners often recruited such individuals from soup kitchens and local welfare offices, and coached them on what to say on various medical forms in order to make it falsely appear that the medical tests to which the defendants intended to subject them were medically necessary. In furtherance of the scheme, Chochiev also made threats of physical violence to individuals who Chochiev believed owed money to the scheme members.

Also in furtherance of the scheme, before the medically unnecessary tests were performed on the Phony Patients, Swaffar and Pinez obtained the Phony Patients’ Medicaid and/or Medicare insurance information, and then contacted the Insurance Providers to confirm that the Insurance Providers would reimburse for the tests. Swaffar and Pinez engaged in such conduct knowing that the Phony Patients were being recruited and paid by the Runners to undergo the tests. Once they determined that a particular Phony Patient’s insurance would pay out claims made by the clinic for the planned medical tests, Swaffar and Pinez notified the Runners that the individuals were eligible and could be brought to the clinic to undergo such tests.

After the Phony Patients had been recruited, confirmed to be Medicare and/or Medicaid eligible, and transported to one of the clinics by the Runners or Chochiev, in many instances certain individuals who were not physicians administered a host of unnecessary medical tests to them. In particular, for example, Fatakhov administered unnecessary medical tests, including stress tests, to the Phony Patients of the Elmhurst Avenue Clinic. Fatakhov administered these tests outside the presence and supervision of the Doctor or other licensed physician, despite knowing that the presence or supervision of a licensed physician was required. After the unnecessary medical tests were administered, the Phony Patients were paid cash kickbacks. The defendants, through the clinics, then submitted fraudulent claims to Medicaid and Medicare seeking reimbursement for the unnecessary medical tests. In total, in the course of the scheme, the defendants fraudulently billed over $70 million to Medicaid and Medicare, for which they received over $25 million in reimbursements.

In addition to the prison term, Judge Abrams ordered LIPKIN, 51, of Brooklyn, New York, to serve three years of supervised release and to pay over $8 million in restitution and forfeiture

As set forth below, all of the other defendants charged in this matter have pled guilty. On January 13, 2017, Pinez was sentenced to six months in prison. The remaining defendants are pending sentencing.

Mr. Bharara praised the outstanding investigative work of the Federal Bureau of Investigation, the New York Police Department, and the U.S. Department of Health and Human Services. He also thanked the New York State Office of the Medicaid Inspector General for its assistance.